Anxiety and Depression Association of America

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Mary Wilde

How Adverse Childhood Experiences Have Serious Health Implications

Despite four years of medical school, three years of residency and over a decade in practice, I was never taught the profound connection between high childhood stress and increased risk of chronic disease. It was at a community event sponsored by our local school district that I first learned it, as I watched the documentary entitled, “Resilience: The Biology of Stress and the Science of Hope.” Suddenly, the medical education I had been accumulating over years and years took a leap in an hour. I felt all at once grateful for the new awareness, yet stunned and also troubled by the deep public health implications. The documentary told about the adverse childhood experiences (ACEs) study, initially published over 20 years ago (but still holding utmost pertinence), which showed people who experienced abuse, neglect, abandonment, poverty and other major stressors in childhood went on to have a hugely increased risk of physical and emotional health problems, including obesity, heart disease, type 2 diabetes, depression, anxiety and addiction. The statistics are staggering, but yet supportive of our intuitive observations all along: high stress is bad for our health. Research has shown chronic stress can suppress the immune system, change blood flow, alter metabolism, increase inflammation and even change how genes are expressed. I knew about all that. But somehow, even as a pediatrician, I didn’t realize it started so young. Featured in the “Resilience” documentary as an early pioneer in the “trauma-informed care” movement, pediatrician Nadine Burke Harris noticed a huge disparity in health between the patients from her inner city clinic and those from other neighborhoods across town. Kids experiencing high stress and trauma tended to fall off the growth charts. Their underlying chronic conditions, like asthma, tended to be more severe or difficult to manage. The children from unstable environments carried a disproportionate number of behavioral health diagnoses like anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Dr. Burke Harris had a patient population with such a high number of traumatized kids that the bodily manifestations of extreme stress became an evident pattern. It led Dr. Burke Harris to do research of her own and to connect with others making parallel discoveries. She tells of it in her book, “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.” Though Dr. Burke Harris first saw profound stress effects in an inner city neighborhood, adverse childhood experiences and other stressors occur among all socioeconomic groups. The ACEs study involved over 17,000 “mostly middle and upper-class, college educated” participants in the Kaiser-Permanente health plan and demonstrated over two-thirds had an ACE score of one or more. As the ACE score got higher, the risk of chronic disease increased as well. In other words, the toxic effects of stress seemed to be dose-dependent. Not all stress is bad — we need a degree of it to stay safe and motivated — but most of us carry more than this functional level. Michele Kambolis, Canadian therapist and author of “Generation Stressed” says, “There has been an exponential shift in terms of our lifestyle. Our culture is now putting an inordinate amount of pressure on children to produce and achieve.” The kids are feeling it. One of my clients, a high school senior, expressed it this way: “Adults want us to be everything. We’re supposed to earn money for college, keep our grades up, be involved in extracurriculars and somehow still find time to sleep, exercise and eat well. It’s an impossibility.” No wonder there are such high rates of anxiety! The data connecting stress to disease need not serve as a prediction of doom, but as a revelation to inspire action. The first step is awareness. Read about the ACEs study. Take the ACEs questionnaire. If you have unresolved traumas from your past, find resources to help you address them. Begin weeding out unnecessary stress in your own family. If you are a parent or caregiver struggling to provide a stable or safe environment for your children, get help. Advocate for the children in your community. Studies show one of the most powerful buffering factors for kids experiencing toxic stress is having at least one supportive, caring adult in their lives. Who in your circles needs you to provide this role? Studies also show a healthy foundation of sleep, nutrition, exercise and coping strategies can also mitigate stress effects. Seek to establish healthy habits in your family. Don’t overschedule your kids. Learn mindfulness. Practice yoga. Go outside. Take a deep breath. As Mahatma Gandhi said, “We must become the change we want to see in the world.” Rather than chasing after our goals at the expense of well-being, let’s care for ourselves and each other. Let the healing begin now.

Renee Collett

20 Photos of People Who Are Anxious at Night

When nighttime falls, it seems like the entire world is asleep. But when you live with anxiety and nighttime falls, it can seen like the entire world is asleep — except for you. Why? Because for many, nighttime offers no break from anxiety. To help others understand the truth about nighttime anxiety, we asked members of our community to share photos and some words that describe this reality. Nighttime anxiety can look different to everyone, but if you can relate, use these photos as a reminder that you’re not alone. Here’s what our community shared: 1. “This is what my anxiety looks like after another failed job interview. I start feeling like I’m not good enough for any job I apply to. This is also in the middle of my  non-cardiac chest pain (NCCP) acting up due to anxiety and I’m trying to not have to go to the emergency room.” — Kimy B. 2. “I hide my anxiety so well. I have to. That smile is just a way to tell everybody I’m OK. This particular picture, I was just fine, until a few minutes later. Trying to make supper for the kids, do laundry, sweep the floor, break up arguments and I just broke. I couldn’t breathe. My heart raced so fast I thought I was going to pass out. I just bawled. I couldn’t help but to fall to the floor. It took a while to come back. The attacks are was worse than they have ever been. I black out and can’t see straight. I lose all focus on everything.” — Chrystal S. 3. “I stay in bed at all times when I’m really anxious. I usually push my pillow under my arms, and use it as a support.” — Joanna L. 4. “Hiding my pain/distress. I only cry when alone and can give in. Wishing the ground would just swallow me up and do everyone a favor.” — Catherine W. 5. “My wife works second shift and sends me pictures of her being cute and goofy. After a panic attack tonight, this is all I could muster to send back.” — Chisa P. Having trouble falling asleep? Download our app to connect with others who may be struggling. 6. “Doesn’t show much, but I’ve been battling my anxiety. It’s so bad that I’m obsessing over a word I couldn’t find. I’ve been attacking my family. I don’t know why I’m so broken. Keeping it inside. Getting ready to take my nighttime pills.”–Cheyenne B. 7. “This is what anxiety at night looks like. I feared socializing. I feared myself.” — Tia S. 8. “ One of my many sleepless nights. She calms me down.” — Dustin S. 9. “ My anxiety means me taking a shower at 2 a.m. because I am unable or unwilling to try to sleep, knowing that my brain won’t stay quiet anyway. It also means trying to get work done and being unable to because I’m so tired.” — Erika K. 10. “Anxiety has always been a part of my life. Anxiety doesn’t have a look; anxiety is simply a face of a person because anyone and everyone experiences it. This photo was taken after having a panic attack in the middle of the night that woke me up. Anxiety is so controlling.” — Emma-Louise J. 11. “ I actually keep an album of pictures of me throughout panic attacks, bipolar mania and depression so I can see how far I’ve come when I look bright in the mirror. It’s an album only for me.” — Summer P. 12. “In this specific photo I wasn’t tired, but my husband was already in bed and I was struggling. I laid next to him and he did this in his sleep. It made me feel loads better and I fell asleep not long after.” — Katt C. 13. “Saw a spider, set off my anxiety. Too alert to calm down and go to sleep. Everything out of place looked like spiders crawling. Too alert and shaky. So, I shuffled through my new oracle deck and gave my friend an oracle reading, hoping we could just chat and I would calm down enough to sleep. I felt guilty for keeping her up, though. But the cards helped me slow down, connect and slowly forget the spiders that I had been scanning the walls and floors for.” — Alysia M. 14. “A selfie that was taken after I got thrown out of a nightclub because I was having a panic attack on the dance floor. All my friends were inside and I was scared out of my mind.” — Jenn H. 15. “ Can’t sleep. I just hide from the world. It’s like a cloud of fog. I ignore the phone and tell my friends I’m busy. I just want to shut the world outside. I want to just curl up in a corner.” — Mish R. 16. “This was me trying to sleep at a program last year where I was living away from my husband. Terrible separation anxiety/co-dependency.” — Kayla T. 17. “ It’s invisible but definitely real, racing thoughts like a hamster on a wheel. That voice that tells you what’s real isn’t real and what you feel isn’t what you feel. That doubt you don’t go a day without. All the words you’ve said that got taken the wrong ways, the words left unsaid that are now stuck on replay. Tears fill the room as you’re gasping for air. You know you can swim but your drowning instead. Nothing can take back the harsh words in your head, so you cry and you cry as you beg for your strength. Keep taking deep breaths hoping the pain blows away.” — Tonia O. 18. “Some people survive and talk about it, some people survive and go silent. Everyone deals with unimaginable pain in their own way, and everyone is entitled to that without judgment.” — Heidi M. 19. “I make Tik Tok videos when I can’t sleep due to anxiety. It gets me out of the anxious head space by focusing on something positive and forcing my brain to be creative. The goal is to make someone else smile and help them cope with their illnesses or whatever issues they may have that day.” — Ashé V. 20. “Silent cries, every night.” — MaKenzie W. Whatever anxiety at night looks like for you, just know that we see you and that you’re not alone. In you’re struggling to sleep tonight, check out the stories below: 16 Products to Try If You’re Feeling Anxious Tonight 20 Songs People Listen to When Anxiety Keeps Them Up at Night 

Nikhita Barath

4 Things to Do When Your Mind Is Riddled With Anxiety

Everything around you is a blur. Voices are not clear. Nothing makes sense. It is hard to process information. There is a tinge of irritability in your voice, a flush of anger on your face. You are on the verge of tears. Nothing seems relevant. Everything is annoying. You want to dive deep into your mindless ocean and retreat into that mind bubble you have created where you can breathe. But a day doesn’t just revolve around you and your thoughts. There are people you need to please. There are responsibilities. There are things to be done. Peace of mind feels like a thing of the past and all you can feel is yourself barely floating in an unending abyss of chores, responsibilities, work, people and everything that makes it hard for you to breathe. Most of us are highly skeptical about sharing our feelings with others but then we find our own ways to cope with the condition of which only we can have the best understanding. You want to cry, you want to scream, you want to sleep but mostly you want it to end. Will it ever end? Unfortunately it is unlikely; it is something one has to live with, but there are things you can do to get through the day. 1. Understand your condition. Most of us do not understand the absolute intensity of our condition. Every person has a different kind of anxiety with triggers that could be the size of a pea or a pumpkin. First, one needs to self-assess how affected they are and to what scale the condition has escalated. This can be achieved with the help of a professional or even by yourself. Being self-conscious and making a mental note of the ebb and flow of your emotional and mental state is key. Once you reach a level of clarity, the path ahead becomes clearer. 2. Make a list of triggers. Triggers are incidents, people or basically reasons that either aggravate your anxiety or bring out your dormant anxiety. A trigger could be anything; it is up to you to find out what ticks you off. I have found it really helpful to keep a journal or make a list of the reasons that induced an episode or even caused the slightest feeling of anxiety welling on the inside. Go through your list every once in a while and you will be able to evaluate the kind of triggers you have and figure out ways to avoid them. Most of the triggers are everyday tasks like getting up from the bed, meeting someone new, making a phone call and such triggers cannot be avoided all the time. But then you will know that doing a certain task causes you anxiety and you could mentally prepare yourself to face the said trigger. 3. Talk yourself down. I have made it a practice to talk myself down during an episode. There are two ways to do this: either have dialogue with yourself or explain the situation to yourself. One always knows deep down what would help in the given situation. Tell yourself to calm down, focus on the issue and make sense of it first. Then you can always think of what your next step should be and what you need to do to make yourself come out of the panic you are feeling. It will never be easy, but then when you get better at it, you will see a huge difference in the way you perceive your anxiety and at some point you will be subconsciously ready for damage control when required. 4. Breathe. Anxiety is often known to make us breathless. People feel like there is this heavy weight on their chest making it difficult for them to breathe. Some people feel like they’ve run up a flight of stairs in a sprint. It is always good to incorporate a breathing regimen. Whenever you find yourself feeling breathless, pause and remind yourself to breathe. No matter how hard it is pull in all the air you can, breathe deeply, hold it for a second or two and then let it go. Breathe in from your nose, breathe out through your mouth. This will help calm your physical symptoms so you can focus on your emotional and mental state. Disclaimer: I am not a professional, but one of you. I understand the struggle and it would bring me great joy if even one person benefits from this article.

Jill Foley

What It's Like to Be a Nurse With a Mental Illness

I am a nurse. However, I am a nurse who has dealt with mental illness almost my entire life. I spend my days treating the physical symptoms of my patients and dealing with my own mental ones. I constantly have anxiety about doing something wrong, hurting a patient or missing something important. I struggle. I put on what my husband and I refer to as my “nursing persona” to get through the days — be happy and smiling for my patients and come home to deal with my anxiety and depression. Some days, the effects of my patient’s situations are too much for me to handle and I lash out at home. I get angry and irritable, but I know that this is due to the horrible situations I encounter and the emotional rollercoaster they put me on. I work as a home health nurse and I visit patients in their home every day. I go into the most lavish homes and I’ve treated patients in their cars because they don’t have a home. I see patients who have simple wounds and are otherwise fine, I see young people dying of cancer while holding their toddler and I see patients who have many different disease processes and refuse to take care of themselves. What astounds me about this is the ability of us health professionals to push those emotions aside and not allow ourselves to feel the trauma that these situations cause. So many of us likely have trauma from the things we have seen, yet we don’t talk about it. We choose to pretend like those feelings don’t exist. But I don’t have that choice. I don’t get to forget about the patient who was 30 years old, had three children and died of cancer while at my service. I feel every bit of that emotion and sometimes, it completely wrecks me. I was diagnosed as a teenager with general anxiety disorder (GAD) and depression. I choose to not take medication anymore because the medicine made me feel like a zombie. But in choosing this, I have had to learn how to cope with my career choice and all the emotional hell it brings. Here are some things I have learned to help me along the way: 1. Deal with the emotions that each situation causes. Don’t allow yourself to keep it inside. If a situation makes you upset, then you should talk about it. I personally use my husband as my sounding board to talk about the horrific things I see and deal with. He is an amazing support and always allows me to cry if I need to. We all have those patients who touch us emotionally and I’ve learned it best to release that emotion. 2. Ask for help. So many companies these days offer employee assistance programs, especially healthcare providers. They know that what we deal with is hard and can cause some serious mental repercussions. Take advantage of the program and seek some help if you are feeling overwhelmed, burnt out or mentally exhausted. 3. Find a healthy activity that helps you release stress. One of the biggest concerns I have is stress management. I have recently discovered yoga and have found it to be extremely calming, especially when I combine it with guided meditation. I force myself to breathe through the exercises and focus on my breathing while I do this to clear my head. It is an excellent stress reliever! 4. Avoid stimulating foods/drinks while feeling anxious. I know this may seem odd, but when I am feeling extremely anxious and my mind is going a thousand miles an hour, coffee makes it worse. I choose hot water with honey and lemon or decaffeinated teas/coffees. It is so calming. 5. Journal your experiences. In healthcare, we are limited in what we can write down. We are restricted by HIPPA laws from sharing any information about our patients, so blogging is generally not an option for us. However, I can journal about my feelings or my experience with a patient. I write daily about emotions I felt and the situation behind the patients. It’s a form of release for me. I release the day after each journaling session. I know so many people struggle with health care professionals not understanding or empathizing with their mental illness. I see it all the time with my patients and I choose to empathize, sympathize and offer as much advice as I can to them. Please know that not all health care professionals view mental illness secondary to physical symptoms. I know how difficult it is to get out of bed every day or to constantly worry that something horrible is going to happen. I deal with those same emotions every day and then add emotional rollercoaster of nursing on top of it. I know the struggle that you are going through, because I’m going through it as well. I see you, I see what you are going through and know that if you are ever a patient, I will be there for you. I took an oath to do no harm to my patients and to me, that is just as important mentally as it is physically.

Susan Smith

When You Both Love and Hate Hypomania in Bipolar Disorder

I have lived most of my life in a continuous hypomanic state with occasional major depressive episodes usually related to a major hormonal event — onset of menses, childbirth and a hysterectomy. I have also, on rare occasion, moved into fully manic states. Until diagnosis, and after a psychiatric admission, I thought I was “normal” — just overly motivated and productive. I was intolerant of “normal” production from my colleagues although I was sought after for many projects when working. When I left one job for another, the party theme was the Tasmanian Devil… at the time I did not understand the reason for this “humorous” send off. When functionally hypomanic, you definitely want me around. I can get a lot done. I am both wildly creative with pyrography and rug hooking and overly proud of my creative output; posting to Facebook every little piece is an example of the “pride” overflow. I am also very functional as a volunteer and sought after in my small community for my areas of professional expertise — fundraising, promotion and community engagement. When functionally hypomanic, I can manage my family life, volunteer commitments and pet care. Unfortunately, like many with a love of their hypomanic state, it always ends up out of control on either end — fully manic or terribly depressed. My husband serves as a constant caregiver and arbiter of the severity of my mood swings — he can usually reel me back in and when he can’t, our doctor is a critical player in assisting us with cognitive behavioral therapy (CBT) and medication modification. I do not recognize when I am moving into dysfunction in social settings and have recruited several close friends to help me identify when I need additional support. I have been diagnosed for about seven years and spent the first three fully dysfunctional — my parents moved in to help with my care and suicide prevention so my husband could work. My son, now 16, keeps my meds schedule on his phone to be my back up in case I “forget,” which I often do. I feel terrible that I need this active and engaged support network but recognize it’s essential to my survival. Without the feedback and loving support, I can easily become suicidal again. My bipolar disorder is coupled with occasional but severe social anxiety resulting in physical illness at public events, and I often “escape” at inopportune moments and run home to hide until the anxiety lifts. Medication helps with this but it is very easy to overdose and be heavily sedated. When manic, I am almost completely insensitive to the emotional states of others in my world and feel that “if they would only do as I say,” all would be well. My friends will now immediately clue me in if I am acting this way and it’s hard to shift gears, so I usually just go home and seek appropriate support from my doctor. We have developed private signals that alert me when I am stepping over the line of kindness and supportive actions. All this being said, I love hypomania. I love the creativity, I love the productivity. I love the kudos and warmth that come my way for my accomplishments. I also hate hypomania because it is a harbinger of much worse times to come. It is inevitable that I will crash or fly. I realize how incredibly lucky I am to enjoy hypomania and to also have the active engaged support network to alert me of “out of control” episodes. Hypomania is my love and my worst enemy. Like many with bipolar disorder, the “normal” is rare and not much fun. I have a lot of other coping mechanisms including worry stones, calming essential oils, a special pet that serves as an unofficial therapy dog, and of course sleep. I generally can sleep seven hours regardless of my state and that is a gift I don’t take lightly. My weight varies considerably during episodes so I have a three-size wardrobe, depending on what side of the illness is affecting my eating patterns. I hide a lot. I produce a lot. I am bipolar. I will survive as a functional person because I admit the range of issues to those closest to me and accept their support. This was not an easy life process to craft and I still “hate” living with bipolar. I also have learned to be kind to myself and stay away from dysfunctional self-blame. I have an illness. I am not that illness. I am consciously designing the right structure for a functional life and it’s a lot of work. It’s worth it. I’m here. I’m mostly happy. I am kinder and gentler with everyone, most of the time. I have bipolar disorder and I will be functional. I owe that to myself and to everyone who loves me.

What It’s Like Being a Therapist With Anxiety

When your profession puts you in a position of perceived perpetual strength, power and “togetherness,” it can be difficult for people to believe that you endure the same stressors and emotions they do. As a therapist, I put on my “superwoman invincibility cloak” every weekday morning to provide the empathy, hope, validation, support and problem-solving my clients need in their lives for our hour or two sessions. About three months ago, my own “stuff” tapped me on the shoulder and I had sit in the other chair as the recipient of help. I am a wounded healer. I am a depression survivor. And I am still out here surviving. My interest in the mental health field stemmed from my upbringing, being immersed in situations and people battling illnesses and addictions that sprouted from seeds of trauma. I had never seen what healing looked like. I wanted to learn more about it. I wanted to do it. People would assume I was fine because I looked fine in my pictures. Most of my time for the last couple of years has been consumed by working and being a full-time student, so what most people think they know comes from their interpretations of the glimpses into my life that were provided on social media. Maybe I wanted people to think my life was perfect or maybe I actually am so private that I was embarrassed to share the lows. After all, nobody is entitled to knowing everything that happens to us. However, the moment I started being a little more transparent about the hardships I was experiencing, a miraculous moment happened: I felt freer. I literally felt the pedestal that my family, friends and stranger friends had put me on being lowered. A pedestal I had kind of wanted to be put on, but not really. Not when that meant people constantly craving a sip from my endless chalice of strength, unknowing that I was down to the last scant drops. Because then, what had happened was, the stress and anxiety started hitting my body. Hard. One day, a few months ago, I was at work speaking to my supervisor and became lightheaded. The exact feeling is indescribable and still scary to think about. I stepped out of his office in shock and fear of losing consciousness, and did not want to drop in front of him. After running to the bathroom to splash water on my face and still sinking into this horrendous debilitation while hyperventilating, I stumbled back into the office and asked the receptionist to call 911. I was transported by ambulance to the emergency room. Inside the ambulance, my heart had to be reset because my pace and rhythm became accelerated to dangerous levels, and the EMS crew had no idea what was going on, either. They were trying to save me from whatever was happening. I had been to the ER a few weeks prior for the same reason: I had almost passed out while I was driving. Being hardheaded and stubborn, combined with the slight terror of losing my new job and being zapped back into poverty (versus the faux poverty of living paying to paycheck), I returned to work a day or two later, and almost passed out again. Woke up on Sunday morning with an accelerated heartbeat, almost passed out again. Ended up back in the ER. Have I made my point yet without being obnoxious? My goal was to be just a tad repetitive by establishing a seamless but predictable sequence of events as I built angst and suspense, but I may have overdid it. We are on the way to a late 20s, wise-beyond-her-years, third (or seventh) quarter life crisis mental health epiphany and will be arriving shortly! Spoiler alert: I was having panic attacks. I was informally diagnosed with panic disorder and generalized anxiety disorder. The way it was described to me was the way I described anxiety to my clients, although I had never experienced it to this degree before: my body’s “fight or flight” response was jacked. Normally and historically, it serves as a useful survival tool, increasing your awareness of perceived threats. For example, when we lived in caves, hunters would sense that a bear was in their vicinity, and the fight or flight response would give them a heads up to flee or target the bear first. Straight survival-of-the-fittest style. The issue here was that no bear was in my vicinity. I was not even consciously aware of fearing or sensing a bear, yet my body was reacting as if I was about to be Winnie the “vicious” Pooh’s snack. Anxiety has looked like getting down on all fours in a crowded store because my body and nerves were physically shaking as parts of my body became numb from lack of blood circulation and oxygen. Anxiety means I have thought about writing this article for weeks, but could not physically get to it. My mind was cluttered and overwhelmed, wanting me to do everything, but instead doing nothing. As I type, I resist the urge to pop an Ativan, telling myself that this is positive stimulation and nervousness: making time for my often neglected but forever pondered about love for writing. Even the act of taking a prescription medication for anxiety is a huge breakthrough: a few months ago (and possibly last week), I was sobbing in a hospital gown in the emergency department, utterly opposed to taking any medication, although my anxiety had finally exploded into a severely disabling state. Years of “being strong,” “pushing through,” and “carrying on” despite the traumas and emotions that remained unprocessed had finally caught up to me—hopped on my head and tackled me into sitting down. Years of suppression and repression, consciously and unconsciously forcing negative, unpleasant or threatening feelings out of my mind in order to function. Sometimes, unleashing these thoughts, feelings and behaviors (in my mind) would have completely disrupted whatever my present goal or survival circumstances were to the point that I would have become a completely unwound puddle of tears and pain. Sometimes, I convinced myself that the admission of my humanity and mortality were weaknesses, perhaps because I had not experienced the privilege of feeling emotionally (and oftentimes, physically) safe growing up. It was a maladaptive coping strategy that had now stopped working. I had lost control. Surrendering to this realization has probably been the hardest pill to swallow to date, pun intended. I share this experience in hopes of normalizing the conversation about mental illness, especially in unassuming communities. Outside of my studies, I had never grasped what it meant to live with anxiety and thought “panic attacks” were just humorous hyperbole for being very nervous or antsy. I did not know they felt like death. I did not know anybody who looked like me who had them. I had never heard them talked about or described in detail. I did not know years of suppression and repression would cause panic and anxiety to sneak up on me. What I had seen and heard of was self-medication and depression, while still not quite comprehending why people chose to ruin their lives by becoming dependent on substances. This was before I became a therapist, and I now know that it is not this simple of a process and actively fight against the stigma. There is power in softness. When we share parts or ourselves, we free both ourselves and someone else. After reading this, someone will no longer postpone addressing their traumas, because he or she does not want to start having panic attacks. Someone will stop self-medicating and seek professional services and resources. Someone will know they are not alone. Gentle reminder, reader; please do not put taking care of everyone else above taking care of yourself. You simply can’t. It is not sustainable. You need you, your body and your health for all of the great things waiting to be accomplished. Everyone needs support and safe spaces to vent. Everyone needs to process their emotions. Everyone needs help, and that includes the helpers and the “strong friends.”

Dr. Tiffany Wicks

Having an Anxiety Attack in Front of Your Daughter

It was just another weekday morning when I had my first anxiety attack in front of my toddler. I was on my way to work and getting my daughter ready for school. As always, my daughter was running around the house, refusing to get dressed. I still had to finish styling my hair, packing lunches and get my work bag ready for the day. It was too much. I dropped the knife that I was using to spread the mayonnaise. My dogs started barking when they heard another dog being walked in the neighborhood. There was now 15 minutes to get out the door and I could feel time ticking. At this point, I’m yelling through the house, trying to find my daughter, begging her to ditch her pajamas. She refused. Ten minutes left. She was screaming and trying to run while I wrestled to at least get a new shirt over her head. She wriggled away. I just couldn’t do it anymore! My heart started racing. Pounding. It was at the surface, and I couldn’t stop it. I start to panic and it happened. I had an anxiety attack right there in front of my toddler. This is the point in the story where I wish I could tell you it didn’t last long or that I had a quick way of coping to shut it down. But that didn’t happen. My anxiety has looked different over the years, from anger to tears to full-blown panic attacks. That day, however, it was tears, which I consider my least traumatizing form of anxiety for others. I started to breathe heavily and the tears started to flow. I began to sob. While I don’t remember much about the attack itself, I will never forget my daughter’s face. Her expression transitioned from her own distress from having to get dressed and go to school, to shock and awe that mommy wasn’t OK. Her mouth dropped and she looked at me confused with her deep blue eyes, trying to figure out what happened. What occurred next brought me so much comfort and so much shame at the same time. My daughter embraced me. My toddler, who doesn’t articulate that well and still runs and loses her balance, grabbed me and held me. She started stroking my arm and saying over and over “It’s OK, mommy. It’s going to be alright.” The anxiety hadn’t totally ended and I was still sobbing, but I became so aware that my small child was calming me in a way that I couldn’t do for myself. In an instant, I was both so proud that I was raising a nurturer while ashamed that she knew how to handle my anxiety better than I did in that moment. However, simultaneously I realized I couldn’t cope without help. I took in her words, felt her embrace and started to breathe through my tears. Gradually, my anxiety quelled and I came back to my reality. All the while knowing that my daughter not only witnessed this, but she helped me through it. That day changed the way I see my anxiety. I work harder to employ coping skills as I see it bubbling. I am more consistent with my treatment and I employ my support system more frequently. However, it taught me a lot about parenting, too. While my daughter saw me in an undesirably vulnerable moment, she knew how to comfort. I taught her that. She knew the words to say without my prompting and knew to try and embrace me. I modeled that for her. Even though I don’t wish for her to take care of me, I learned that I am raising a good human who models what I do and watches how I act. And as a parent with anxiety, I determine what she should know about my mental illness and how I set the example of resilience through it. For someone who struggles with anxiety, there are a mix of emotions that I feel in the midst of an attack, especially around other people. I feel vulnerable, exposed, overwhelmed and pressured to get better quickly so no one knows how often and how intense my anxiety really is. But when it’s my child, those feelings can be heightened because as a parent I believed the lie that I have to always be OK for her. The truth is, hiding my struggle with mental illness doesn’t help her. It furthers the stigma that mental illness is wrong, bad and is a human flaw. Over the years, I’ve worked so hard to embrace my anxiety as part of who I am and how I cope is part of my strengths. When I hide this from her, I’m hiding part of me. Do I need to show her all my anxiety? Absolutely not. Regardless of what age, I have to do my own work to take care of and parent her and continue to cope through my day. But I want her to know that I’m not always OK and that’s a part of life for any person. I want her to see my use my coping skills whether it’s generalized anxiety or if I happen to have an anxiety attack in her presence again. When I show her this, I’m giving her skills that can carry her through her own bad days, whether or not she has anxiety. Just like she knew to reassure me because I do that for her, how I overcome the tough things in life also teaches her how to keep going. I know my first anxiety attack around her probably won’t be the last. But what I learned from the first experience will shape the rest. My anxiety isn’t just about me anymore, but it’s about what I show her as she’s watching me. While I hope my anxiety attacks in front of her are minimal, I hope she knows that her mom is not her mental illness. I want her to see my rise through the difficulty and see that anxiety won’t stop me, but it will teach me something and make me stronger. And ultimately, I want her to learn that no matter what her tough days look like, she will rise too.

Dealing With Anxiety at Social Events

Humans are social creatures. Even the most introverted person will need companionship at some point to fight feelings of loneliness. There has been a notable rise in loneliness among not just the older and vulnerable, but the young and supposedly “functioning” adults (I wrote a post about this here). While we know we need to socialize for the sake of human nature, why is it so darn hard? I am naturally a loner. I am introverted and I prefer my own company to literally anyone. There is nothing I love more than being at home, in my nest, doing my own thing. Being with people can limit who I am as a person. It’s not that I despise people; I just find myself struggling to understand the people around me, which can cause me to feel really stressed. I was always the unpopular kid with the introverted parents, so I never stood a chance. Maybe this is because of my traumatic childhood or maybe it’s just how I am programmed. Whatever the reason, social events make me quake in my boots. Unfortunately, no one is completely immune to social events. Be it for Christmas, a birthday or a charity event, I will have to leave my home at least once a year and face social interaction. It’s terrifying. Honestly, I’d rather sit in a room full of puppies; can I do that instead? I try to tell myself that because I don’t see people often, I should enjoy it. I try to remind myself that once the event ends, I will be free. I spend more time bargaining with myself than the time spent at the actual event itself. I guess socializing feels like a prison sentence for me. I’m just not good with people. My throat literally feels like it’s swollen shut and no words will come out. Not to mention, those incredibly uncomfortable, itchy and clammy hands that make me want to spend the duration of the event at a sink. It’s not to say I always hate social gatherings. I do sometimes enjoy being around others. Christmas wouldn’t be the same without family around the fire and holiday movies on television. There are times when my body literally craves a night out with friends or an adventure to the next town over. Just because I usually hate the idea of these events doesn’t mean they never appeal to me. This is something I want my friends to know. Please don’t exclude me from plans because you know that I am likely to say no. Being invited out makes me feel valued and you never know, I might just say yes. Socializing is stressful, for sure. My body goes into this rubber band mode where I feel myself being torn back to my safe place: my room. Sometimes it gets to be too much so I will just leave, which makes me worried that I’m a bad person. Palms sweaty, ears muted and my mind in another generation– it’s like I lose myself with an audience. So, how do I deal with this? We can’t avoid people forever, unless we tried really hard. I once avoided leaving my house for a year, and didn’t see friends for three years, but it drove me into a relapse. Through this experience, I’ve developed some tips for handling this stress. This is my handy list to help you get through those difficult social interactions: Be yourself. I’m guilty of spending hours before an event redoing my makeup over and over again, and trying on every outfit in my closet. I practice what I need to say and rehearse  my persona for the night. Social pressure can make me feel like an alien, so I do what I can to fit in. But this isn’t healthy and will only make the situation more stressful. Don’t worry about what people will think. Bring your true self and if your friends don’t like it, that is their problem, not yours. Remember: you’re worth it. It can be easy to let people encourage you to do things that you may not feel comfortable doing, especially while at social events. When there are many people pressuring you and making you feel like you will be rejected or judged for not following their ways, you may conform to their pressures. But you are forgetting your worth, your values and a part of who you are. Who you are is your identity and your worth, and you are worth more than a group of people trying to change you. You are allowed to say no and walk away! Communicate. How many times have you wanted to leave a party, ask for a drink or find the bathroom, but you couldn’t because your anxiety left you voiceless? Then you end up leaving the party exhausted, upset, with a full bladder and a throat drier than the Sahara Desert. I know exactly how hard it is, but you can ask for help. You will not be judged for having human needs and if you are, why spend another moment in that situation? Be honest. Have you lied to the host or a friend when they noticed you struggling? When they have encouraged you to rest, go home or find a moment of peace, have you just said you were OK, just tired? A real friend will care about your well-being, and they don’t mean to insult you by suggesting that you go home to rest instead of staying at the event when you are clearly unhappy. Be honest and if you want to take their advice, you have every right. Breathe. It sounds pretty basic, right? Breathing is literally needed for us to survive, and social events are no exception to this human necessity. But we can often forget to pace our breathing and calm ourselves when we feel our blood pressure rising and our anxiety stamping its feet. Follow your instincts, find quiet places away from music or people and bring yourself back down to a calmer state. You are only human and you don’t have to brave it, even when you believe that people expect it of you. Social events are supposed to be an enjoyable experience for everyone. It’s a chance to let go of daily struggles and see people you care about. A mental illness does not need to limit that; you deserve to have fun and enjoy these events just as much as the next person. Listen to your heart and don’t be afraid to ring those warning bells; you’ll make it through any social event in one piece.

Renee Collett

Anxiety Thoughts People Have at Night

For those who have anxiety, nighttime can be tough. Anxious thoughts you had during the day can also come out at night, and those anxious thoughts can keep you awake when all you want is rest. It’s easy to feel isolated when anxiety keeps you up at night. Sometimes your anxiety makes you concerned about your safety. ( Did I lock the door? Are the windows shut? Are all the lights off?) Other times, it focuses on your work or school life. ( Did I do enough at work today? I need to do more to prove to my supervisor that I’m a good employee.) Nighttime anxiety thoughts can even make you dwell on the past or the future. ( I’m so overwhelmed with tomorrow. I made too many mistakes that led to this.) You may feel alone in these thoughts, but others face similar nighttime anxiety thoughts, too. We wanted to know what anxious thoughts keep people up at night, so we reached out to our mental health community. If you struggle with these anxious thoughts at night, know you are not alone. Here’s what our community shared with us: “’I didn’t get even close to as much done as I should have, and everyone is going to think I’m lazy because of it.’”– Sam M. “‘What if I sleep through my alarm? I can’t be late. What if I forget to set my alarm?’” — Katie S. “‘Is the door locked? Is the baby breathing? Is the dishwasher going to set the house on fire while we’re sleeping? Did I take my pill? Is the baby breathing? What day of the week is it? Did I wash my uniform? Did I take my pill? I really should drink more water.’” –Nicky P. “I always worry about waking up late for work or not being able to get enough sleep in to feel good in the morning for work.” –Lisa K. “The night before an appointment that I don’t want to go to (or any appointment), I just think about it and just worry about it because I hate appointments.” — Vicki C. “Reoccurring panic that some one is breaking in, or the house will catch fire while I sleep. Nighttime is awful.” — Jessica B. “‘I need to get some more sleep or I’ll be exhausted today. If I’m too exhausted, I’m just going to feel worse.’” — Lulu B. “Cue a whole reel of embarrassing memories that make me ashamed of myself that keep me up for an hour or more, and then cue me getting so emotionally fatigued that I fall asleep.” — Jacob B. “‘I’m so overwhelmed with tomorrow. I made too many mistakes that led to this. I have had to ask for help. I want to be independent, but I am unable.’” — Douglas T. “Any banging sound outside or animal sound sends the anxiety back up and the loop starts again. It’s usually just foxes making the noise, but anxiety says it is my cats in trouble.” — Alysia M. “I worry that I didn’t do enough that day and end up feeling bad for resting and recuperating. It makes me so anxious because I know I can’t get that time back. It’s frustrating, especially when I needed that rest.” — Julia F. “‘Geez, I shouldn’t have napped. It threw me off. Now I’m not sleeping.’” — Maria G. “Every night I have a reoccurring thought that spirals out of control and keeps me up for hours before I can finally fall asleep. That thought is about waking up in the morning. I always fear waking up in the morning and getting through yet another day. I think of all the things that can go wrong when I wake up that morning and that triggers a panic attack.” — Emelie P. “‘It’s going to happen again. I’m going to dream of him cheating on me, and it will happen.’”– Alejandra S. “‘Will I be able to graduate college? Will the professor of the class I need understand my anxiety disorder?’” — Alex L. “‘Sunday nights are the worst. Tomorrow is Monday. I have to go back to work. What if my boss yells at me? What if I get fired?’” — Anne S. “‘Is tomorrow going to be a good day? A bad day? Am I going to make it through the day without a panic attack?’” — Manda J. “Right when I’m about to sleep, every single night since I was little, I always feared someone came into the house and was waiting around somewhere. So every night I get up, check every room, even the laundry room and go back to bed feeling reassured and can fully go to sleep.” — Monica S. “At night when I’m already in bed, I start to think about all the things I did during the day, and I find myself constantly hating the lack of activities I have (especially on Friday nights), and I start to question everything, from why I didn’t go out to why I didn’t tell my friends that I wanted to go out.” — Rocio I. “‘What nightmare will I have tonight? Am I ever going to be OK? Will I ever not be lonely and unloved?’ In my waking daytime life, I know that I’m loved by my kids, but lately nighttime means severe anxiety.” — Amanda E. “‘Did I lock the door? Are the windows shut? Are all the lights off? Is that footsteps? Is someone in here?’” — Emi S. Although nighttime anxiety thoughts can make you feel exhausted and isolated, you’re not alone. If you’re looking to ease your anxiety at night, check out some of these helpful posts below that may give you some good ideas of where to start: 19 Tips for When Anxiety Keeps You Up at Night How to Manage Sunday Night Anxiety A Letter To the Person Up All Night With Anxiety

What I Wish I Could Tell My Students as a Teacher With Anxiety

Hi Guys, Your ideas are important, your words are something to be treasured and you always matter. I’m sorry if it doesn’t always look like I am with you. I don’t hope that you understand, but I hope you accept. Sometimes, I’m not always with you. I am fighting my own self-imposed monster that I don’t share with all of you because of some irrational fear that you will care for me less, my teaching will somehow become pointless and that you’ll think I’m a fraud. I suffer from anxiety and sporadic bouts of depression that can make it so hard to come to work and teach you every day that I put on a mask. It’s those days that I read to you out of a book and assign some pointless questions you all know I’ll grade easily because I’m just not fully there with you as I should be and as I want to be. Sometimes my brain doesn’t allow me to accept your compliments, your smiles and your kind words. I physically hug you back, give you that high five or give you that arm nudge, but I don’t always accept your care. I don’t always feel worthy of your kindness and I wonder why you all spend your free minutes with me when I am such a mess. It’s why sometimes I ask, “What are you doing here?” and it’s not because I don’t want you, but because I cannot fathom what you see in me. Sometimes I worry about you too much. My worry and concern go beyond my English classroom. I wonder if other teachers notice little changes in your attitudes or personalities. I wonder if your parents see how great you are or what you may need. Then I wonder if I put these needs on you from my own brain when in reality, you are completely fine and need nothing but quality English instruction from me. When I leave hours after you are released from the metaphorical 9 a.m. to 5 p.m., I’m not done. My brain continues thinking on the drive home, when I’m doing laundry, when I’m trying to sleep. You matter always. Sometimes when I ask,“You OK?” I genuinely want to know if you are, in fact, OK. “Need anything?” is how I say, “I notice something different about you and I don’t know what to do and I don’t know if you actually want my help.” These little phrases help me function and when you say you’re OK, it allows me to fall asleep a little easier, reassuring myself with your answers that I will see you another day and keeping myself out of the downward spiral of repetitive thoughts. The “what ifs” will wait for another day. The phrase, “I understand more than you even know.” is my way of trying to tell you I’ve been there and I’m probably there right now, but I’m being strong for you. I’m keeping all of my things together with a string the thickness of dental floss because I think you need me. The sleepless nights you tell me about, the assignments that seem to never end, the conversations you replay in your head on a never ending loop — I do the same. I’m with you. Thank you for all the positive Post-It notes, the candy you leave on my desk when you know it’s been a rough day and the many times you write little notes to me in your assignments telling me I am doing a good job. Always,Ms. K.